Introduction: This information is provided to give you and your family a basic knowledge of the total hip replacement operation, outlining the things you should know, both before and after surgery. The aftercare may vary depending on the surgeon in charge of your care. The success of your operation is very much a team effort including you, your family, Doctors, Nurses and Physiotherapists. Your Physiotherapy team: Physio Plus proudly provides all inpatient physiotherapy services at the Mater Mackay Hospital. We are a QIP Accredited physiotherapy practice and all our physiotherapists are members of the Australian Physiotherapy Association. While it s unlikely you ll meet all of us you can expect to see more than one physio during your stay in hospital. Tom Denis Amy Sam Chris Stephanie Danae Zac Of course we would be delighted if you choose to continue your rehabilitation with Physio Plus as an outpatient just call us for an appointment when you leave hospital. You ll be in very good hands! Page 1 of 9
What is a hip replacement? A total hip replacement operation replaces the worn or damaged head of the thigh bone (femur) and relines the cup (acetabulum) with hardwearing materials. These materials are either coated with synthetic bone into which your natural bone grows, or they are strengthened using bone cement. Precautions: Three precautions must be followed after hip replacement surgery to prevent dislocation. Dislocation is very rare, but this will help to avoid it. 1. Do not bend the operated leg more than 90 degrees. That is, do not let your knee come to the height of your hip. 2. Do not cross your legs even at the ankles. The operated leg must always be held out to the side away from the midline of the body. When sitting try not to twist the foot of your operated leg inwards or outwards. Do not use your operated leg to remove shoes or slippers. 3. Do not twist the operated leg in or out avoid rotation. When walking you should always keep your toes and kneecap pointing straight ahead. When turning use small steps and always turn away from your operated leg. If in doubt always ask your physiotherapist, surgeon, or nurse. Page 2 of 9
Mobility and transfers: 1. Getting in and out of Bed You will require some help with this initially. Always get in and out of bed smoothly and slowly to protect your new hip and always get of bed on the side of your operation. Sit up in bed and ease your legs out one at a time keeping your operated leg in line with your upper body. Pivot your bottom round until you are sitting on the edge of the bed with both feet on the floor. Push up from the bed and stand using the strength of your non-operated side. Once you are standing upright, take hold of your frame or crutches. RIGHT Hip Replacement get in and out on the RIGHT side. LEFT Hip Replacement get in and out on the LEFT side. Getting back into bed is the same as above but in reverse. Always ensure that the backs of your legs are touching the bed or chair before you sit down. Move your bottom back onto the bed until the backs of your knees are on the bed before pivoting yourself around into a lying position. Initially, you will need supervision and assistance every time you get in and out of bed. Remember it s easier to get up from a higher chair and you will need to sit in higher chairs to prevent dislocation. 2. Walking Before discharge the Physiotherapist will show you how to safely and correctly use your gait aid, typically forearm crutches. Remember the crutches must always be supporting the operated leg. In most cases you will be on two crutches for around six weeks. If and when you move to one crutch or one stick you will use it on the opposite side to your hip replacement. Remember you are required to bring your own crutches to the hospital. Generally it s cheaper to buy a pair then rent some. We have a range of aids including crutches at Physio Plus so you re welcome to buy them at our practice (Suite 27 in the Mater Medical Suites). If you have a Veteran s Gold Card please tell your physiotherapist the cost of these devices is covered by the Department of Veterans Affairs. Page 3 of 9
3. Stairs Before you leave the hospital the Physiotherapist will show you the easiest and safest way to go up and down stairs, even if you don t have stairs at home. It s important you know how in case you come across them! To go up stairs: 1. The unaffected leg should step up first. 2. Then bring the affected leg up to the same step. 3. Then bring your crutches up. To go down stairs: 1. Put your crutches on the lower step. 2. Bring the affected leg down to that step. 3. Step down with the unaffected leg. Simply remember Up with the good, down with the bad. Always take one step at a time. Page 4 of 9
Postoperative Exercises: Recovery: These exercises are essential for increasing circulation to your legs and feet to prevent blood clots. You may begin these exercises in the recovery room shortly after surgery. It may feel uncomfortable at first but these exercises will speed your recovery and may reduce your postoperative pain. 1. Deep Breathing After any operation it s most important to get air to the bottom of your lungs to prevent chest infection. Perform 5 long and deep breaths through your Triflow then cough twice. Repeat hourly. 2. Ankle Pumps Slowly push your foot up and down. Do this exercise several times as often as every 5 or 10 minutes. This exercise can begin immediately after surgery and continue until you are fully recovered. After your return to the ward: Complete 10 repetitions of the following 3-4 times per day on both legs. 1. Hip and Knee Flexion Slide your heel toward your buttocks, bending your knee and keeping your heel on the bed. Do not let your knee roll inward. 2. Buttock Contractions Tighten buttock muscles and hold to a count of 5. 3. Static Quads Tighten your thigh muscle. Try to straighten your knee. Hold for 10 seconds and then rest for 20 seconds. Repeat this exercise for a 10-minute period or until your thigh feels fatigued. 4. Straight Leg Raises Tighten your thigh muscle with your knee fully straightened on the bed. As your thigh muscle tightens, lift your leg several inches off the bed. Hold for 5 to 10 seconds. Slowly lower. Repeat until your thigh feels fatigued. Page 5 of 9
Standing Exercises: Your physiotherapist will guide you through these exercises, usually two to three days after your operation. You will eventually complete 10 repetitions of the following 3-4 times per day using your operated leg. 1. Standing Hip Abduction Be sure your hip, knee and foot are pointing straight forward. Keep your body straight. With your knee straight, lift your leg out to the side. Slowly lower your leg so your foot is back on the floor. 2. Standing Knee Raises Lift your operated leg toward your chest. Do not lift your knee higher than your waist. Hold for 2 or 3 seconds and put your leg down. 3. Standing Knee Bends Slowly lift your heel back backward toward your bottom. Try to keep your back straight. Hold for 2 or 3 seconds. Return your foot to the floor. Page 6 of 9
Functional Pathway: This is the optimal pathway from a functional point of view. You re function is very important in determining when you are ready to go home. There are many other important measures the physiotherapist will have in mind, including goals for strength and movement. Of course your goals are most important, that s why we specifically ask you about these during your preoperative consultation. Day 0 Day 1 Day 2 Day 3 Day 4+ Operation Stand, walk on a frame and sit out if able Walking on crutches Exercises and stairs Home Dos, Don t and Common Mistakes: Do ask if you re ever unsure, don t assume! Don't cross your legs at the knees or feet. Don't bring your knee up higher than your hip. Don't lean forward while sitting or as you sit down. Don't try to pick up something on the floor, especially while sitting. Don't turn your feet excessively inward or outward when you bend down. Don't reach down to pull up blankets when lying in bed. Don't bend at the waist beyond 90 degrees. Don't stand pigeon-toed. Do cut back on your exercises if your muscles begin to ache, but don't stop doing them! Do expect to need lots of assistance for the first few weeks. Discharge Outcomes: Before you go home the Physiotherapist will expect you to: Have adequate pain control Have adequate wound healing Have affected hip flexion to 75 degrees and extension to 10 degrees Have sufficient strength globally around the hip Be safe and independent with your gait aid (crutches) Be safe and independent on stairs Be independent for transfers Be very aware of your hip precautions Page 7 of 9
After you leave the hospital: It is essential you complete your rehabilitation. You will require outpatient physiotherapy. You have a choice of physiotherapists but you are welcome to attend our private clinics in Mackay or Whitsunday. We also visit several other locations regularly. You will need to make these appointments. Everyone is different so your physiotherapist will guide you on the amount and frequency of outpatient rehabilitation you require. Typically it is at least twice a week initially. Naturally if you progress very well you won t see much of us, but if you don t meet the milestones we expect you ll see us regularly! Remember this operation changes your weight bearing surface an operation does not improve your strength and function this is a partnership between you and your physiotherapist. The focus of acute inpatient physiotherapy is to get you functioning well enough to go home, once you see our team as an outpatient we ll work towards your specific goals. Our aim is to get the best function possible from your new hip. If you move well, you ll stay well. Your Physiotherapist will be happy to answer any questions or concerns! Just ask. Page 8 of 9